Onycholysis is the separation of the nail from the nail bed. It is typically a painless separation and tends to be a common problem. Onycholysis can be a sing of skin disease, and infection or the result of injury but most cases are seen in women from long fingernails. The function of a nail serves a lever, prying the nail away from the skin and preventing healing of small damages
Onycholysis spontaneous separation Of the nail plate starts at the distal free margin and processes. IN onycholysis the nail plate is losses from the underlying and lateral surprising structures. In fewer of cases, separation of the nail plate begins at the proximal nail and extend to the free edge, which is often in nails with psoriasis (termed onychomadesis). In rarer cases of onycholysis are confined to the nails lateral borders.
Nails that have onycholysis are normally firm smooth and do not exhibit inflammatory reaction. Onycholysis is not a disease of nail nutrition levels. However, nail discoloration may appear underneath the nail as a result of secondary infection. When onycholysis occurs, a coexistent yeast infection may be suspected. Treating the primary and secondary causes of onycholysis is critical in order to prevent the condition from getting worse. If onycholysis is left untreated, severe cases of onycholysis may result in nail bed scarring.
It is not known how many cases of Onycholysis occurs nor if the ethnic distribution of onycholysis known, however, it has been observed to take place in all ethnic groups. Both male and females can develop onycholysis, although women seem to produce more of cases onycholysis than men. People of all ages can develop onycholysis. However, the condition is primarily found in adults.
Treatment for onycholysis will vary and depend on the severity. Removing the predisposing cause of the onycholysis is the best treatment. Onycholysis associated with psoriasis or eczema may respond to a midstrength topical corticosteroid. Pulsed dye laser treatment as been found as an effective solution of psoriasis induced onycholysis in a small serious of the test, but more research is needed. Psoralen plus ultraviolet A (PUVA) treatment has been reported to work as an effective therapy of psoriatic onycholysis. However, patients should ensure the following:
- Avoid trauma to the affected nail, keep the nail bed dry
- Avoid exposure to contact irritants and moisture (critical)
- Clip the effect portion of the nail and keep the nails short
- Wear light cotton gloves under vinyl gloves for wet work
Intralesional may be required for people with more severe psoriatic nail dystrophy.
Triamcinolone 2.5-5 mg/ml diluted with normal saline is injected into the proximal nail fold every four weeks in a series of 4-6 sessions.
The portal nail food overlying the nail matrix is the ideal site for treatment of diseases that begin at the matrix (psoriasis)
A 30-guage needle is sufficient for medication delivery: a topical anesthetic may be used to reduce pain.
Improvement should start after the initial series; continued injection depends on disease recurrence.
For other nail changes associated with onycholysis oil drop sign of psoriasis, distal onycholysis, subungual hyperkeratosis) the best location for intralesional injection is the nail. The pain of this procedure necessitates the use of anesthesia. This problem can be curved come by injection the lateral nails fold in an attempt to get medication to the affected area.